Alarming Cesarean Section Trends in India

When certain issues arise during pregnancy or labour, a caesarean section (C-section) delivery is a life-saving medical treatment for women and babies.

World Health Organisation’s Estimation of C-section Rates:

A 2015 WHO report states that a population’s optimal C-section rate should be between 10% and 15%. This rate illustrates how successfully C-sections can reduce maternal and new born mortality when they are performed when they are required.

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According to research by the WHO, maternal and new born mortality fall as countries increase their caesarean section rates by up to 10%. However, there is no correlation between lower rates of maternal and neonatal mortality and caesarean section rates higher than 10% (3^✔ ✔Trusted Source
WHO Statement on Caesarean Section Rates

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).

National Family Health Survey-5 Findings on Caesarean Section

Together, the National Family Health Surveys from 2015 (NFHS-4) and 2019 (NFHS-5) provide enough information about the number of C-sections performed in India. According to NFHS-4, India’s C-section rate of 17.2% was greater than the WHO-recommended limit. Same way, the rate is 21.5%, higher than ideal limit in NFHS-5 also.

State Wise Trend in Caesarean Section Delivery Rates

Telangana, with a startling 60.7% of all deliveries over the previous five years, has reported the highest percentage of C-section births, followed by Andhra Pradesh (42.4%), Jammu & Kashmir (41.7%), Goa (39.5%), and Ladakh (37.6%).

A relatively moderate increase, between 5 and 10%, has been documented in nine states and UTs. The northeastern states of Manipur (8.2%), Mizoram (10.8%), and Nagaland (5.2%) have the lowest rates of C-sections and the smallest percentage increases since NFHS-4.

In reality, only Mizoram, Lakshadweep, and Nagaland saw a decrease in C-section rates between NFHS-4 and NFHS-5 (1^✔ ✔Trusted Source
National Family Health Survey (NFHS-5)

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Soaring Number of C-Section Deliveries a Concern for Maternal, Children Health

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Comparison of Caesarean Section Performed in Private and Public Facilities

When data were examined more closely on a state-by-state basis, it became clear that most states had seen an increase in caesarean births and that most people preferred private healthcare facilities to public ones.

Nagaland had the lowest percentage of C-section births in private health institutions, at around 23%, which suggests that private health facilities nationwide overused C-Section births. Twelve of the 22 states and UTs had more than 50% of births via C-Section, and three of those had more than 80%.

More than 90% of C-Section births were place in private medical facilities in Tripura and Jammu & Kashmir. The percentage of C-Section births was substantially lower in public health facilities. Telangana had the largest percentage of C-Sections performed in public health institutions (44.5%), while Bihar had the lowest percentage (3.9%).

In 16 states and UTs, public facilities overused C-sections, and in four states and UTs, including Mizoram, Meghalaya, Nagaland, and Bihar, where the share of institutional births was on the low side, they were below 10%. In comparison to NFHS-4, the three northeastern states have similarly shown a decline in C-Section births. In comparison to NFHS-4.

Ladakh, Sikkim, and Goa reported a rise in C-Section births at public health facilities of greater over 10%. (5^✔ ✔Trusted Source
NFHS-5: Share of Institutional Births & C-Sections increase in most States

Go to source,6^✔ ✔Trusted Source
47.4% babies born in private sector via C-section, far above 14.3% in govt facilities, NFHS shows

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What Could be the Possible Reason for this Rise of Caesarean Section ?

The widening disparity, according to experts, may be caused by a number of factors, including the country’s increased health insurance coverage since the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana’s launch in September 2018.

The PMJAY offers qualified families Rs 5 lakh in annual health coverage. C-sections are what are referred to as “moral hazard” procedures in the insurance industry since they are frequently performed for financial reasons rather than medical necessity.

The other option is that when fertility declines, first-order deliveries increase, which could necessitate C-sections due to their complexity.

States in the north and east have extremely low rates of C-sections, while states in the south and west have quite high rates, demonstrating a significant geographic difference in availability to crucial surgical treatment, particularly in public health facilities.

The private sector frequently caters to riskier pregnancies due to a lack of experts in public hospitals, especially in rural parts of the northern and eastern states. As a result, they might have a greater percentage of C-sections (7^✔ ✔Trusted Source
Cesarean births on the rise in India but Mizoram, Nagaland defy trend: NFHS-5

Go to source).

The other important factor to be considered is obviously profiteering – as a Caesarean Section surgery is going to be billed at a higher rate than a normal vaginal delivery. Particularly worrying is states like Telangana and Andhra Pradesh.

Some surveys also indicate that many young girls opt for C-sections for two reasons. First is to avoid pain of vaginal delivery and second is to ensure that there is no loss of vaginal anatomy leading to laxity after child birth that may lead to interference with their sexual function. This is particularly true with celebrities and women from higher social strata.

What can be Done Now to Reduce the Growing Rate of C- Sections?

Campaigns to raise awareness of the value of a normal birth when no signs of medical difficulties are present in the mother need to be run using a variety of communication methods.

The government could start by educating people on the value of normal vaginal deliveries for healthy expectant moms, which will increase women’s knowledge of maternal health.
Frontline professionals who are the initial point of contact for pregnant women for antenatal care, check-ups, or other health issues can assist with this, such as community health workers and primary care doctors.

It is imperative to create a mandate specifying that C-section deliveries should only be performed when absolutely essential from a medical standpoint, and to put that demand into action in the states where the C-section rate is excessively high.

Additionally, it needs to be investigated whether private hospitals force patients to have C-section deliveries in order to increase their revenue.

About National Family Health Survey 2019-21 (NFHS-5):

• The National Family Health Survey 2019-21 (NFHS-5), employed 17 Field Agencies completed the NFHS-5 fieldwork in India in two phases. They gathered information from 636,699 households, 724,115 women, and 101,839 men between June 17, 2019 and January 30, 2020 for 17 states and 5 UTs, and between January 2, 2020, and April 30, 2021 for 11 states and 3 UTs (1^✔ ✔Trusted Source
  National Family Health Survey (NFHS-5)

  Go to source

  ).




• The National Family Health Survey-5 Key findings were just made public. The study gathers thorough data on demographics, health, nutrition, and other topics with a focus on mothers and children. The survey’s results give estimates for 131 indicators.




• These findings include a separate section on delivery care that includes data for each of the 22 states and UTs that made up the first phase of the survey on the type of birth, such as a caesarean section, reliance on public and private health facilities, and presence of skilled medical personnel for delivery. Births that occurred five years before to the survey are included.

References :

1. National Family Health Survey (NFHS-5) – (http://rchiips.org/nfhs/NFHS-5Reports/NFHS-5_INDIA_REPORT.pdf)
2. C-section – (https://my.clevelandclinic.org/health/treatments/7246-cesarean-birth-c-section)
3. WHO Statement on Caesarean Section Rates – (https://www.who.int/news-room/questions-and-answers/item/who-statement-on-caesarean-section-rates-frequently-asked-questions)
4. Soaring Number of C-Section Deliveries a Concern for Maternal, Children Health – (https://science.thewire.in/health/nfhs-5-caesarean-deliveries-increasing-concern-maternal-neonatal-health/)
5. NFHS-5: Share of Institutional Births & C-Sections increase in most States – (https://factly.in/nfhs-5-share-of-institutional-births-c-sections-increase-in-most-states/)
6. 47.4% babies born in private sector via C-section, far above 14.3% in govt facilities, NFHS shows – (https://theprint.in/india/21-5-of-all-births-in-india-are-through-c-section-far-above-who-ideal-of-10-15-shows-nfhs/771710/)
7. Cesarean births on the rise in India but Mizoram, Nagaland defy trend: NFHS-5 – (https://www.downtoearth.org.in/news/health/cesarean-births-on-the-rise-in-india-but-mizoram-nagaland-defy-trend-nfhs-5-80374)

Source: Medindia